Type 1 diabetes is a lifelong disease, but researchers at Stanford University are hoping to eliminate the effects of the disease -- and eventually cure it -- with a new vaccine.

Researchers from the Stanford School of Medicine -- led by Lawrence Steinman, MD, professor of pediatrics and of neurology and neurological sciences at Stanford -- have created a DNA vaccine that fights type 1 diabetes by targeting only a certain population of cells in the immune system without destroying the whole thing.

The vaccine consists of an altered piece of DNA, which holds the proinsulin gene. Beta cells, which are the only cells that make insulin in the body, start out as proinsulin precursor proteins. The beta cells, like all cells, display small pieces of the proteins they make on their surfaces called peptides, and the proinsulin peptides on the surface of beta cells cause misdirected CD8 cells (which are immune cells that patrol the cell surfaces for foreign peptides) to attack the beta cells.

The new DNA vaccine seeks out CD8 cells only targeting proinsulin; not all CD8 cells. If the vaccine had shut down the normal behavior of all CD8 cells, it would interfere with the patient's immune system and stop their bodies from being able to fight off infections and serious issues like cancer. Hence, shutting the whole system down isn't a better option.

To test the vaccine, the research team recruited 80 type 1 diabetic patients that required insulin therapy. They divided the patients into five different groups, where four received different doses of the vaccine and one received a placebo.

Over the course of 12 weeks, the researchers measured levels of C-peptide in the patients, which is a piece of proinsulin that is cut off when insulin is pulled out of the proinsulin molecule. C-peptide is thought to fight off diabetic complications, such as eye and kidney damage.

The team checked the C-peptide levels before they began, then at five and 15 weeks, and then six, nine, 12, 18 and 24 months after starting on the vaccination. During these checks, blood was drawn 30, 60, 90 and 120 minutes after patients drank a modified milkshake.

According to results, levels of proinsulin-targeting CD8 cells were significantly depleted in patients who received the vaccine, compared with those getting placebo. However, other CD8 cells remained intact and left alone. Patients on the vaccine either had the same C-peptide levels or even increased levels, which would help them fight off diabetic complications later in life.

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